Nasopharyngeal carcinoma: Experience and treatment outcome with radical conformal radiotherapy from a tertiary care center in India

Lifestyle, Epstein-Barr virus infection, and other factors could impede nasopharyngeal cancer survivorship: a five-year cross-sectional study in North Eastern India

Nasopharyngeal Carcinoma (NPC) is one of the leading cancers in India's north-eastern (NE) region affecting a section of the population each year. A proportion of the NPC cases are observed to recur even after therapy, indicating the involvement of other factors. We aimed to explore the NPC and Epstein-Barr virus (EBV) burden in the NE region and investigate the prognostic factors for the NPC patients' poor survival and recurrence. NPC patients' information was obtained from different state hospitals between 2014 and 2019. PCR and Sanger sequencing were performed to detect EBV types. Statistical analysis, including forest plot analysis, Kaplan-Mayer survival plot, Log-rank test, cox hazard regression, and Aalen's additive regression model, were performed to determine prognostic factors for the NPC patients' lower survival and recurrence. We observed an increased incidence of NPC and EBV infection in the past five years. Step-wise statistical analyses pointed out that variable such as non-professionals (B = 1.02, HR = 2.8, 95%CI = 1.5,4.9) workers (B = 0.92, HR = 2.5, 95%CI = 1.4,4.4), kitchen cum bedroom (B = 0.61, HR = 1.8, 95%CI = 1.2,2.8), mosquito repellent (B = 0.60, HR = 1.7, 95%CI = 1.1,2.7), nasal congestion (B = 0.60, HR = 1.8, 95%CI = 1.2,2.8), lower haemoglobin level (B = 0.92, HR = 2.5, 95%CI = 1.3,4.9), tumor stage IV (B = 2.8, HR = 1.8, 95%CI = 1.6,14.3), N2 (B = 1.4, HR = 4.0, 95%CI = 1.8,9.1), N3 (B = 1.9, HR = 6.4, 95%CI = 2.8,15.3), and M+ (B = 2.02, HR = 7.5, 95%CI = 4.1,13.7) revealed significant correlation with NPC patients' poor prognosis (p < 0.05). The presence of viral factors also showed a significant association with NPC patients' decreased survival. We concluded that factors related to day-to-day life with EBV infection could be the individual predictor for NPC incidence, lower survival, and disease recurrence.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13337-022-00789-5.

Clinical Outcomes and Prognostic Factors of Locally Advanced Nasopharyngeal Cancer Treated with Intensity Modulated Radiotherapy: First Experience Report from Northeast India

The aim is to retrospectively evaluate the clinical outcomes and prognostic factors in patients of locally advanced nasopharyngeal cancer (NPC) treated with intensity-modulated radiotherapy (IMRT). The northeastern states report relatively more NPC cases in comparison to other states of India. This study is an attempt to assess the treatment outcomes and prognostic factors of locally advanced NPC who had been treated with definitive radiotherapy with or without chemotherapy in our institute from 2012 to 2016 using IMRT. This is a single institutional retrospective study. Thirty-one consecutive patients of locally advanced NPC treated with definitive chemoradiation using the IMRT technique between 2012 to 2016 were evaluated. The survival was analyzed using Kaplan-Meir method and their relations with various clinicopathologic parameters were compared. After a median follow-up time of 36 months, the 5-year overall survival (OS) and disease-free survival (DFS) was 47.3% and 26.1% respectively. The younger patients of < 50 years had improved OS (p = 0.05). Patients of stage IVA had inferior 5-year OS (p = 0.1) and 5-years DFS (0.02) than those of stage III. The patients who received neoadjuvant chemotherapy showed improved DFS at 5 years (p = 0.09). The treatment-related toxicities were within acceptable limit. This retrospective analysis has reported outcomes of locally advanced NPC patients treated with IMRT with concurrent chemotherapy when IMRT was first introduced in our institute. This is the first of its kind from the Northeastern region of India.

Concerns of a Post-Chemotherapy/Radiotherapy Patient of Nasopharyngeal Carcinoma Presenting with Sustained COVID-19 Infection

A 47-year-old patient was referred from otorhinolaryngologist with a chief complaint of hearing loss to the medical oncology department where he was diagnosed to have nasopharyngeal carcinoma (NPC). The patient was given six cycles of chemotherapy and 35# of radiotherapy. After a week of therapies, he developed a low-grade fever. He was suspected of COVID-19, but the reverse transcription polymerase chain reaction test came out to be negative. He developed urinary retention, and he was planned for suprapubic catheterization. Before the procedure, he was retested for COVID-19 which came out to be positive. This case report aims to describe the condition of a patient of NPC with COVID-19 infection and to discuss the outcome of disease in this circumstance.

Metastatic Nasopharyngeal Carcinoma: Outcome from Cancer Institute, Chennai

Background: Optimal management of metastatic nasopharyngeal carcinoma (NPC) at presentation is debatable. The aim of this study was to investigate the treatment outcome of patients with metastatic NPC treated with concurrent chemoradiation or with radiation alone and to analyze the factors that correlate with the outcome. Methods: This was a retrospective study of patients with metastatic NPC treated in Cancer Institute, Chennai, from 1996 to 2015 with either chemoradiation or only radiation. Factors including age, sex, stage, treatment type, and type of metastasis were correlated with the outcome. Statistical analysis was done using SPSS version 20, and survival was estimated by Kaplan–Meier’s curve. Results: A total of 515 patients with NPC were treated during this period, and among them, 74 patients (14%) had metastasis at the time of presentation. The median follow-up was 14 months; the median progression-free survival and overall survival (OS) were 11 months and 19 months, respectively. About 72% (n = 53) were treated with chemoradiation and the rest 28% (n = 21) were treated with radiation alone. The 3-year OS was better in patients who received chemoradiation (39%) as compared to those who received only radiation (23.8%). Patients with the bone-only site of metastasis had better survival. Among them patients with oligometastatic bone disease (1–3 sites) had a better 3-year OS (51%) as compared to multiple bone metastasis (>3) 15.8%. Conclusion: Chemoradiation can be an option to treat metastatic NPC. Patients with oligometastatic bone disease had better survival.